Harm Reduction vs. Criminalization: Drug Policy in the Balance

The War on Drugs has permeated US drug policy since the early 1970’s, paving America’s way to the dubious honor of having the highest incarceration rate in the world. Yet despite this, drug addiction is still a tremendous social, economic, health, and law enforcement problem.

America continues to struggle with psychological, ethical, and moral issues about drug policy. Some of these issues are legacies of past anti-drug campaigns (“Drug use is a choice! Just say no!”) or the strong desire for law and order (“Drug users know they’re doing something illegal, so why shouldn’t they be punished?”) Other issues are regularly refreshed on the nightly news, such as the constant stream of stories linking drug use with violence and death. More and more people have personal experience with the devastating toll drugs can take on family and friends, and there are persistent worries that relaxing drug penalties will encourage drug use, especially among the young.

Recently, however, there is a growing movement in the United States to focus less on incarcerating drug users and more on reducing the harms of drug addiction such as disease, crime, and joblessness. Such harm reduction strategies include needle exchange, heroin replacement, expanded treatment programs, and decriminalization of some or all illegal drugs. There is compelling scientific evidence that such approaches lead to better outcomes for users, reduce the spread of disease, and save public money in the process. Yet these strategies have met with mixed amounts of public support. Their proposals seem counter-intuitive: how will making it safer to use drugs and reducing penalties solve the problem? How do we know things won’t get worse? It’s not like we can do the experiment, right?

Actually, it’s already been done…by Portugal.

In 2001, Portugal decriminalized personal drug use (though not sale or distribution). Ever since, Portugal has provided much-needed real-world data on harm reduction strategies (summarized by the Cato Institute here). Purchase, possession, and consumption of illicit drugs for personal use is still prohibited, but they are seen as administrative rather than criminal offenses. Charges are brought before special Dissuasion Commissions that issue mandates and fines that are often waived conditionally upon treatment. Undoubtedly, this policy reduces penalties for drug use and places the emphasis on treatment rather than punishment. So, how has Portugal’s drug culture responded?

Some effects of decriminalization are most notable for their absence. There was no explosion of drug use (though more people say that they have tried illicit drugs at some point in their life, the percentage of habitual users is the same as or lower than neighboring countries.) There was no increase in “hard” drug use (in fact, Portugal’s drug use rates are below the EU average.) There was no increase in the number of drug offenses (in neighboring Spain drug offenses have nearly doubled in the same time period.) There was no spike in drug-related crime. There was no influx of recreational drug users from other countries (the vast majority of those cited for drug use are Portuguese). In short, decriminalization had little effect on drug-related offenses.

But is Portugal’s system any BETTER than a criminalized system? By several readouts, yes. Treatment programs are better funded and more widely used. Addicts are more likely to seek treatment now that they don’t risk arrest and imprisonment. There is anecdotal evidence that decriminalization has allowed Portugal’s police to focus their efforts on more serious crimes, such as drug trafficking. Most impressively, the rates of HIV, TB, and hepatitis infections have decreased, as have drug-related deaths. Tens of thousands of nonviolent offenders have been kept out of prison, where they would be a drain on public funds and have a reduced chance of reintegrating as productive members of society once they were released.

Though Portugal’s model might not be directly translatable everywhere, it is a compelling example of how an almost exclusive emphasis on treatment can be a viable strategy for dealing with drug addiction.

What do you think? Is Portugal’s example applicable to the US? Where should the line be drawn for harm reduction vs. criminal penalties? Let us know in the comments!